Nasal surgery, including septoplasty and turbinate reduction, plays a pivotal role in optimizing nasal airflow and improving multimodal treatment outcomes for obstructive sleep apnea (OSA). While nasal surgery alone has a limited impact on reducing the apnea–hypopnea index (AHI), it significantly enhances continuous positive airway pressure (CPAP) adherence by lowering airway resistance and reducing therapeutic pressure requirements. Additionally, it improves nasal breathing, mitigates snoring, and contributes to overall sleep quality. Recent advancements, such as mini-invasive septoturbinoplasty (MIST) and distraction osteogenesis maxillary expansion (DOME), offer structurally targeted and minimally invasive approaches to nasal airway optimization. Adjunctive therapies, including nasal irrigation, further enhance surgical outcomes by promoting mucosal healing and reducing congestion. Despite its benefits, nasal surgery should be integrated within a holistic, patient-specific treatment strategy, combining CPAP, oral appliances, weight management, and multilevel airway surgery for optimal results. Future innovations, including AI-assisted surgical planning and 3D modeling, are expected to refine patient selection and enhance long-term efficacy.